Sheppard, Fiona
(2018)
How clinical supervision is accomplished in groups of pre-registration student nurses when they are facilitated by nurse educators.
DHSci thesis, University of Nottingham.
Abstract
The literature suggests many positive benefits of Group Clinical Supervision (GCS) with pre-registration students facilitated by lecturer supervisors. It helps students hone their reflective and critical decision-making skills, and engagement demonstrates working with peers is strongly linked with developing self-awareness and empathic understanding of others. It normalises shared practice experiences and is experienced as supportive and restorative. However, positive findings of GCS are enhanced when the learning environment feels safe and sensitively facilitated and reduced when this is diminished. In addition, several issues are identified as problematic, intriguing or unexplored. These include; methodological approaches, group and supervisory relationships, perceived coercion versus engagement, perceived value of challenge, lack of clarity around the operationalisation of functional and reflective models, differing experiences of men and women.
It is argued that the analytic method known as conversation analysis (CA) addresses some of the methodological concerns in the literature and uncovers how social action in GCS is played out through talk-interaction. Nine two-hour sessions of GCS were filmed with a convenience sample recruited from one post graduate entry cohort, of pre-registration student nurses over a twelve-month period, encompassing sessions including four different lecturer supervisors. Talk was selected, transcribed and analysed to reveal how participants orient to each other’s conduct.
Three clear themes emerged from the findings; power, challenge and empathy. Power; supervisors were apt to remind student participants of inferential frameworks and the multiplicity of roles influencing their relationships. As these reminders were embedded within the talk-interaction, there was frequently an accountability for participants to respond in an expected way potentially compounding disempowerment and oppression already experienced as a subordinate group in the practice setting. A Foucauldian perspective recognised concern raised in the data about surveillance through the supervision process and through filming itself. Challenge, is conceptualised as a facet of reflective learning. However, the findings in this study note that aspects of challenge and confronting were conducted in a tentative way, and participants were wary of making what is private, public. Mezirow’s theory of perspective transformation and Freire’s work on emancipatory education are used to theorise how a more critical approach to reflection can be developed empowering nurse’s own emancipation. Further findings underpinned by Rogers’ core conditions for a conducive learning environment suggests that whilst supervisors play a critical role in facilitation of GCS, it is the unmediated empathy of peers that provides the restorative support so valued by student participants.
The experience of men in this study did not emerge as of local procedural relevance in the CA however, it is posited this may have been associated with the membership bias of the researcher as a woman and suggests this topic needs focused attention in future research.
This study responds to the call for renewed expansion in clinical supervision research agendas. The value in employing a new way of exploring the experiences of participants in GCS has led to providing a more detailed picture of interactional practice and added new dimensions to understanding. The potential for using a similar methodology in other facilitated small group settings where person centred approaches are central to their process, has been presented. The impact of co-constructed narratives towards either increasing or distancing shared empathy may be illuminating in a range of settings where such relationships are critical.
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